Acute aortocaval fistula (ACF) is a rare, life-threatening condition with a complex clinical presentation, making prompt diagnosis challenging. Primary ACF is believed to be associated with abdominal aortic aneurysm (AAA) rupture in 80% of the cases. Thrombotic complications following endovascular repair for acute ACF are rare and less widely recognized. A high index of suspicion is required for diagnosis of this postoperative complication. We describe a novel, staged management approach using endovascular aortic stent grafts (Gore Excluder; Flagstaff, CA) in both the abdominal aorta and the inferior vena cava (IVC) in a patient with a ruptured AAA and acute ACF with subsequent acute IVC thrombosis.
